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Eur Heart J. 2018 Jan 7;39(2):102-110. doi: 10.1093/eurheartj/ehx491.

Long-term survival and causes of death in patients with ST-elevation acute coronary syndrome without obstructive coronary artery disease.

Author information

1
Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, 2100 Blegdamsvej 9, Copenhagen, Denmark.
2
Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 København N, Copenhagen, Denmark.
3
Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical Center, 1500 E. Medical Center Dr, Ann Arbor, MI 48109, USA.
4
Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark.
5
Department of Cardiology, Gentofte Hospital, Copenhagen University Hospital, Kildegårdsvej 28, 2900 Hellerup, Denmark.
6
Department of Cardiology, Nykøbing Falster Hospital, University of Southern Denmark, Fjordvej 15, 4800 Nykøbing Falster, and Odense, Denmark.
7
Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistr 52, 20246 Hamburg, Germany.

Abstract

Aims:

We aimed to study survival and causes of death in patients with ST-elevation acute coronary syndrome (STE-ACS) with and without obstructive coronary artery disease (CAD).

Methods and results:

We included 4793 consecutive patients with STE-ACS triaged for acute coronary angiography at a large cardiac invasive centre (2009-2014). Of these, 88% had obstructive CAD (stenosis ≥50%), 6% had non-obstructive CAD (stenosis 1-49%), and 5% had normal coronary arteries. Patients without obstructive CAD were younger and more often female with fewer cardiovascular risk factors. Median follow-up time was 2.6 years. Compared with patients with obstructive CAD, the short-term hazard of death (≤30 days) was lower in both patients with non-obstructive CAD [hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.27-0.89, P = 0.018] and normal coronary arteries (HR 0.31, 95% CI 0.11-0.83, P = 0.021). In contrast, the long-term hazard of death (>30 days) was similar in patients with non-obstructive CAD (HR 1.15, 95% CI 0.77-1.72, P = 0.487) and higher in patients with normal coronary arteries (HR 2.44, 95% CI 1.58-3.76, P < 0.001), regardless of troponin levels. Causes of death were cardiovascular in 70% of patients with obstructive CAD, 38% with non-obstructive CAD, and 32% with normal coronary arteries. Finally, patients without obstructive CAD had lower survival compared with an age and sex matched general population.

Conclusions:

STE-ACS patients without obstructive CAD had a long-term risk of death similar to or higher than patients with obstructive CAD. Causes of death were less often cardiovascular. This suggests that STE-ACS patients without obstructive CAD warrant medical attention and close follow-up.

KEYWORDS:

Causes of death; Non-obstructive coronary artery disease ; ST-elevation acute coronary syndrome ; ST-elevation myocardial infarction ; Survival

PMID:
29029035
DOI:
10.1093/eurheartj/ehx491

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